New laser technology available for removing cataracts

U. of I. among 1st in Midwest to offer LenSx surgery system

Dr. Jose de la Cruz checks Merle Gordon's eyes during a follow-up visit after she had laser surgery to treat her cataracts at the Millennium Eye Center, a satellite clinic of University of Illinois.
(Brent Lewis, For the Chicago Tribune)

After learning she needed cataract surgery for her weakening eyesight, Merle Gordon decided to wait a few months until her ophthalmologist could offer laser surgery with more precision.

She's glad she did. Gordon received a new type of laser surgery on both eyes rather than the traditional blade method at the University of Illinois Hospital and Sciences System. The university is one of the first academic medical centers in the Midwest to offer the LenSx Laser surgery system by Alcon, an ophthalmologic pharmaceutical company, for cataracts.

"It was almost no recovery and in terms of side effects there was nothing," said Gordon, of Chicago. "By the next day in both cases, everything was much clearer and brighter."

That's the result Dr. Jose de la Cruz, who performed the surgery, said he expected.

"There have been no studies yet but in our surgeries we noticed a quicker recovery as far as vision and limited inflammation after surgery, said de la Cruz, professor of ophthalmology and visual science at the University of Illinois at Chicago and assistant director of the Millennium Park Eye Center, the university's downtown satellite clinic.

The procedure is used to break up the cataract, which is then removed using ultrasound, and an intraocular lenses implanted, sometimes multifocal ones. LenSx had already been used in refractive surgery to create a thin flap in the lens and correct eyesight. The University of Illinois is also using the new system for cataracts to train residents.

Having a cataract is almost "like seeing through a stained glass," de la Cruz said about the clouding of the lens, which affects eyesight. According to the National Institutes of Health, most cataracts are related to aging, and by age 80, more than half of Americans either have a cataract or have had cataract surgery.

The new femtosecond laser technology gives a real-time image of the eye, allowing the surgeon the exact required depth "to the micron" for the incision, de la Cruz said. A femtosecond is one-quadrillionth of a second and offers an "extremely short burst of energy." De la Cruz and his team have performed about 80 surgeries since earlier this year and expect to hit the 150 mark this fall.

Not everyone is a good candidate for the surgery, which is not used on adults who have had prior cataract surgery or on children.

During the procedure, the laser helps make a "perfect circular hole so we can enter in, cut the lens to pieces to remove it from the sac," de la Cruz said. During traditional cataract surgery, a manual blade is used for the procedure. An anesthetic is used to numb the nerves in and around the eye in both cases.

"There is less energy time inside the eye, less inflammation inside the eye and it limits the amount of complications that can happen, even in training", de la Cruz said of the laser method, adding it also offers more stability in implanting intraocular lenses.

The new method could soon catch on at other hospitals as well, with Northwestern University Feinberg School of Medicine awaiting arrival any day. Advocate Illinois Masonic Medical Center already uses this laser system.

Dr. Surendra Basti, associate professor of ophthalmology at Northwestern, said it was a "revelation" how well the laser worked at opening the cataract and breaking it into pieces. Basti traveled to the Dominican Republic to try the surgery, using a similar system called Catalys and made by OptiMedica Corp. even before it was FDA-approved for cataract surgery in the United States late last year.

"I think the main advantage of the laser (over current cataract surgery techniques) is the precision and probably a little more safety," Basti said, noting less ultrasound is needed if the cataract is first "softened by the laser."

Basti also said the method helps ensure the patient is more likely to obtain "eyeglass freedom."

"Also, since the laser does a very precise job, the expectation is that over time, the outcomes may be better sustained with laser cataract surgery," Basti said.